Atropine - instructions for use, dose, side effects, contraindications

Causes mydriasis and paralysis of accommodation, increases intraocular pressure, reduces secretory activity of salivary, sweat, bronchial glands, causes bradycardia.

When parenteral administration has antiarrhythmic effect.

It is an antidote for cholinesterase inhibitors, muscarin.

In large doses excites the central nervous system.

Pharmacokinetics:

When administered orally, it works for 4-6 hours, with parenteral - for 2-4 minutes.

Connection with blood plasma proteins - up to 18%. Penetrates through the blood-brain barrier.

Half-Elimination (half-life) of the drug is 2 hours. Metabolism in the liver. Elimination by the kidneys, about 60% unchanged.

Indications:

It is used for peptic ulcer of stomach and duodenum, intestinal colic, symptomatic bradycardia, as a means of premedication, for poisoning with anticholester preparations and holinostimulants, as well as organophosphorus compounds. Used to relieve laryngospasm in bronchial asthma; with the purpose of reducing the tone of the intestine and stomach during X-ray examinations.

In ophthalmology it is used to dilate the pupil, examine the fundus, achieve functional rest in trauma and inflammatory diseases of the eye.

ICD-10

VII.H15-H22.H16 Keratite

VII.H15-H22.H20.0 Acute and subacute iridocyclitis

VII.H15-H22.H20.1 Chronic iridocyclitis

VII.H30-H36.H34 Vascular occlusion of the retina

IX.I30-I52.I44 Atrioventricular [atrioventricular] blockade and blockage of the left leg of the fascicle [Gis]

X.J00-J06.J05 Acute obstructive laryngitis [croup] and epiglottitis

X.J40-J47.J42 Chronic bronchitis, unspecified

XI.K20-K31.K26 Duodenal ulcer

XI.K20-K31.K25 Stomach ulcer

XI.K20-K31.K31.3 Pylorospasm, not elsewhere classified

XI.K55-K63.K58 Irritable Bowel Syndrome

XI.K80-K87.K80 Gallstone disease [cholelithiasis]

XI.K80-K87.K85 Acute pancreatitis

XIX.S00-S09.S05 Injury of the eye and orbit

XIX.T36-T50.T48 Poisoning with drugs that are effective for smooth and skeletal musculature and respiratory organs

Contraindications:

Keratotonus, iridescent iris, closed-angle and open-angle glaucoma.

Individual intolerance.

Carefully:

Age over 40 years is the danger of undiagnosed glaucoma.

Cardiovascular diseases with a tendency to atrial fibrillation (ischemic heart disease, arterial hypertension, stenosis of the mitral valve).

Reflux esophagitis, achalasia of the esophagus, intestinal atony.

Children's cerebral palsy, Down's disease.

Pregnancy and lactation:

Recommendations for Food and Drug Administration (US Food and Drug Administration) - Category C. It is used in cases where the risk from the application is lower than the expected consequences. Penetrates into breast milk, with prolonged use suppresses lactation.

Dosing and Administration:

Use in children.

Applies from 3 months of age.

With a view to premedication - from the newborn period: 10-15 mcg / kg - subcutaneously. From 1 month to 12 years: 10-30 mcg / kg. At the age of 12-18 - 300-600 mcg / kg.

In ophthalmology - from-3 months of age - eye drops in the form of 1% solution.

Inside, 300 mg every 4-6 hours.

When poisoning with M-cholinomimetics, anticholinesterases and organophosphates - 1.4 ml of 0.1% solution intravenously.

Premedication: 0.5 mg intramuscularly 45-60 minutes before anesthesia.

X-ray examinations of the gastrointestinal tract: 0.25-1 mg orally half an hour before meals 3 times a day. When dryness occurs in the mouth, the dose of the drug is lowered.

Bradycardia: 0.5-1 mg intravenously, repeated administration after 5 minutes if necessary.

Local application: 1-2 drops of 1% solution up to 3 times a day with an interval of 5-6 hours. Subconjunctival or parabulbar - 0,3-0,5 ml of 0,1% solution.

The highest daily dose: 3 mg.

The highest single dose: 600 mcg.

Side effects:

Systemic application: dizziness, dry mouth, tachycardia, urine retention, constipation, photophobia, mydriasis, paralysis of accommodation, impaired tactile perception.

Topical application: hyperemia and edema of the conjunctiva, tachycardia.

Allergic reactions.

Overdose:

Visual impairment, unsteadiness of gait, difficulty breathing, drowsiness, hallucinations, hyperthermia, muscle weakness.

Treatment. Introduction of physostigmine: intravenously from 0.5 to 2 mg at a rate of up to 1 mg per minute, not more than 5 mg per day or neostigmine methylsulfate intramuscularly 1 mg every 2-3 hours, intravenously - up to 2 mg.

Interaction:

Antacids containing aluminum or calcium carbonate reduce the absorption of atropine in the gastrointestinal tract. It is recommended to maintain an interval of at least 1 hour.

With simultaneous use with phenylephrine, the development of hypertension is possible.

Procainamide enhances the effect of atropine.

Atropine lowers the concentration of levodopa in the blood plasma.

Special instructions:

Due to the low effectiveness of atrioventricular blockade of the distal type, the use of atropine is not recommended.

To avoid getting the drug into the nasopharynx, when installing the solution of atropine in the conjunctival bag, it is necessary to press the lower lacrimal point.

The dilatation of the pupil in people with intensely colored iris occurs more slowly - one should fear an overdose.

Mydrias caused by atropine is retained for 7-10 days and is not removed after the installation of cholinomimetics.

Driving the car is permissible not earlier than 2 hours after the installation of atropine in the conjunctival sac.

Instructions

Atropine (Atropinum)